Tell us your Ulcerative Colitis story
Have you been diagnosed with Ulcerative Colitis? (Optional)
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Yes
No
Not Sure
Not Applicable
Does Ulcerative Colitis impact relationships with family or caregivers? (Optional)
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Yes
Somewhat
No
Not Sure
Not Applicable
Does Ulcerative Colitis impact your daily exercise or other activities? (Optional)
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Yes
Somewhat
No
Not Sure
Not Applicable
Does Ulcerative Colitis impact your mental health? (Optional)
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Yes
Somewhat
No
Not Sure
Not Applicable
Does Ulcerative Colitis impact your healthcare costs? (Optional)
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Yes
Somewhat
No
Not Sure
Not Applicable
Are you currently looking for a Ulcerative Colitis clinical trial? (Optional)
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Yes
No
Not Sure
Not Applicable
First Name
Last Name
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Age (Optional)
Postal Code (Optional)
Gender (Optional)
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Gender Variant/Non-Conforming
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How would you like to be contacted? (Optional)
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What would you like researchers to know about your experience with Ulcerative Colitis? (Optional)
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